2012 VA HEALTH, INCOME AND OTHER BENEFITS

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1 2012 VA HEALTH, INCOME AND OTHER BENEFITS By Thomas McCormack 3/10/12 Most Americans aren t aware of benefits which are available to all active military service veterans and especially disabled veterans -- and they and the benefits due them are too often overlooked. Here s a brief surveyof income and health coverage programs for veterans of active duty--- if theyhave general or honorable discharges. VA Disability Pensions For Needy Wartime Veterans Veterans who are permanently and totally disabled or over age 65 and have served at least 90 days active duty, including at least one day during the periods that the VA defines as wartime (see page 31)--- even if they never actually entered the war zone---can receive pensions for non-service-connected disabilities (that is, even disabilities not arising from the time in service) if their incomes and assets are below certain levels. In 2012, the pension level for a single veteran without dependents is up to $1, monthly and additional amounts are added and paid for invalids and those with dependents. But see the sidebars below for more details about pension income levels, for the officially-recognized (and therefore qualifying) wartime dates and for details about, and exceptions to, the extra two-years-of-service minimum rule for those who first enlisted after September 7, Income and Asset Rules For VA Pensions In spite of its name, the VA pension is, in fact, a needs-based welfare program: those with low enough assets, and countable income below the applicable pension amount, receive pension payments to bring them up to that pension level. Thus, all other countable income-- except needs-based welfare payments such as Supplemental + The VA insists on calculating, totaling---and even just stating the amounts of---pensions on an annual basis---unlike the monthly basis used by other needs-based programs. Yet when actually paid, benefits are issued in monthly checks, and rounded down to the next whole dollar. CANN th St., NW Washington, DC (202)

2 Security Income (SSI), State SupplementaryPayments (SSP) added by many states to SSI, Temporary Aid to Needy Families (TANF, formerly AFDC) welfare, state Temporary Disability Assistance (TDA) welfare, state General Assistance (GA) welfare and state Home Relief (HR) welfare, as well as the value of Medicaid, other needs-based medical benefits, and food, housing and energy assistance -- reduces the pension payment dollar-fordollar, and if the other income is high enough, it prevents any pension eligibility at all. (SSI and SSPs are welfare programs for the needy aged & disabled; they re distinct from regular Social Security (SSDI & OASDI), which is an earned insurance payment based on wages on which one paid FICA work payroll taxes. ) Veterans spouses and even their minor children s own, separate assets and income if they re sharing a common household with the veteran---are counted together with the veteran s own. But, in 2012, the first $9,750 a year of a minor child s earnings are disregarded.) Allowable assets---or Net Worth as the VA calls it--- originally included one lived-in home and one vehicle of any value; and $80,000 in savings, investments, retirement funds and the value of other real estate, other vehicles and boats but, beginning in 2010, the VA began much more flexibly applying its Net Worth asset test for both pensions and medical care., and no longer relies literally on the former hard-and-fast $80,000 level (see the regulations at 38CFR3.275 and the VA s policy issuance M21-1MB, Part V, Subpart iii, 1. J68). VA pensions cannot be garnished for private debt, except for child support and alimony orders (for details, see 8/5/98 testimony of VA General Counsel before the House Veterans Committee, searchable at Disability Standards For VA Pensions To qualify for a pension, a wartime veteran need not show that his or her disability arose from the time on active service. But he or she nevertheless must be considered permanently and totally disabled---which generally means being rated 100 percent presently disabled) currently by the VA under its disability regulations.---even if from a malady that started after discharge. (But financially eligible veterans over age 65 don t have to be found medically disabled to get pensions; their age alone qualifies them.) The VA disability definitions and rules are similar to, but somewhat more liberal---with far less clinical detail explication--- than those of Social Security. Unlike Social Security, however, the VA will consider such purely social factors as chronic unemployability. And, bylaw, it must resolve all borderline or doubtful questions in favor of the veteran. Disabilityis determined by VA review of veterans submitted military and even non-military medical records, physician statements, military records, written testimonials from military and civilian colleagues, co-workers and supervisors, etc.---and, almost always, ratings examinations which the VA orders to be performed by VA physicians at VA medical centers. Pensions For Surviving Spouses and Disabled Grown Children of Wartime Veterans Surviving spouses of wartime veterans can also collect VA pensions if they are poor enough. Unlike veterans, they need not show that they re disabled themselves or even that the wartime veterans they survive were disabled or received VA pensions when they were still alive. Even grown disabled children of wartime veterans -- again, if they re poor enough -- can receive VA pensions, although in these cases such a grown child (called a helpless adult child by the VA bureaucracy) must satisfy VA disability standards by submitting his or her own medical records, appearing for a VA ratings examination and proving that his or her own disability started before age 18. (However, such grown disabled children need not have been found disabled by Social Security, either as minors or as adults.) See the chart below for pension levels that apply to surviving spouses, their dependents and surviving helpless adult children. (The last surviving widow of a Union Civil War soldier---who wed the veteran, surely by then in his 80s, as a much younger bride in the 1920s--got a VA pension until her own death in CANN th St., NW Washington, DC (202)

3 2002. In May, 2003, former VA Secretary Principi stated on C-SPAN that about 10 long-grown-up, but thenquite-old, disabled helpless adult children of Union Civil War soldiers were then still receiving VA pensions! ) Pension Add-ons If You Need Aid & Attendance or Are Housebound Pension levels of veterans are increased by up to $ monthly in 2012 if the VA finds they need Aid and Attendance, or A & A (surviving spouses and surviving disabled grown children can also get smaller A & A increments). This broad class covers almost anyone who can medically document that he needs help because of substantial limitations with mobility, standing, getting in or out of bed, housekeeping, dressing, grooming, bathing, toileting, eating, meal preparation, errand, communication, social interaction, mental acuity, chore capabilities and other basic Activities of Daily Living (ADLs). Those who receive extra Aid and Attendance payments---while they re intended for paying the costs of medically necessary, disability--related personal assistance and care---are not required to prove they actually spend the add-ons on such care. A similar increment---$ monthly in is added to pensions of those veterans whom the VA determines are physically House-bound. by their conditions This category defines itself, but is far less widely used ---and pays far less---than the Aid and Attendance add-on. Pensioners cannot receive both types of add-ons at the same time. Authorizations for Aid and Attendance and Housebound pension increments for veterans and their surviving spouses and helpless adult children require the submission of medical documentation of that need and, almost always, appearance for a VA ratings examination. See the sidebar below and the Improved Pension Rate Tables at and get excellent layperson-friendly advice and guidance on navigating the application process for both veterans wartime disability pensions and survivor pensions---and Aid and Attendance (A & A) add-on payments for both at has a very comprehensive, extremelydetailed and quite complex website). If their other VA-countable income is low enough, wartime veteran and their widow(er)s can even use Pension and Aid and Attendance increments to help pay for---or, if necessary, to help Medicaid pay for---nursing home, home and communitybased service or home attendant care(see pages 37 and 38). VA Pensions, Supplemental Security Income (SSI) and Medicaid VA pensionscount all familymembers income to reduce (and, iftheotherincome is high enough, even to eliminate) the pension payment: wages, private pensions, regular earned Social Security benefits, bank interest, investment income, rent from roomers and boarders etc. (Again, though, in 2012 up to $9,750 yearlyof a minor child s earnings are disregarded.) But welfare-type payments, such as Supplemental Security Income(SSI), State Supplementary Payments (SSPs) added to the SSI level, Temporary Aid to Needy Families(TANF, formerly AFDC), General Assistance, state TemporaryDisability Assistance, Home Relief, food stamps, the value of Medicaid-paid medical care, energy assistance and housing aid don t count as income for VA pension purposes. But the reverse is not true: SSI, SSPs, TANF, welfare, food stamps, Medicaid, energy and housing programs do count that basic portion of VA pension income meant for the support of the pensioner veteran himself---but not necessarily any additional increments meant to support spouses and dependents as income to him even though it is a welfare-type payment. However, SSI, SSPs, Medicaid and other welfare programs will attribute, or deem, onlythe pension s dependent increment itself(and not the veteran s own basic portion of the pension allowance) to spouses and children themselves (and only to them) when and if they themselves are the SSI, SSP, Medicaid, food stamps, housing, energy or welfare applicants. These other welfare programs shouldn t ever count the Aid and Attendance and Housebound add-ons to pensions as anyone s income: they re exempted from being counted because they re grants to cover medical care purchases rather than income per se. Where this comes up, it often requires one to painstakinglyexplain (even with verification documents or notes one mayhave CANN th St., NW Washington, DC (202)

4 to askfor andget from the VA) the dependentportion ofbasicpension checks and the A&A and Housebound payments and their purpose to get SSI, SSPs, Medicaid, food stamp, housing and home energy assistance and other welfare programs exempt them from being counted as income. Whatall this meansisthat someonewho ison SSI, an SSP, Medicaid orotherwelfareprograms willnothavetheir simultaneous receipt of these benefits counted as income by the VA, but SSI, SSPs, Medicaid and other welfare programs may well count the VA pension or some portion of it in determining welfare eligibility for a veteran or his or her dependents. Since this sort of situation can get quite complex with families in which both the VA pension and SSI, an SSP, welfare and/or Medicaid are received or are being applied for, expert advice from VA-experienced legal aid attorneys or other advocates is a must. The VA Pension Doesn t Count Income Spent on Unreimbursed Medical Expenses (UME) As already mentioned, in counting income, the VA disregards (that is, it does not count toward eligibility or how much a pension payment will be) a child s earnings up to $9,750 yearly in In addition, income above 5% of the prior year s basic pension amount for a family of that size but not including of any add-ons to the pension level for Aid and Attendance or Housebound status -- is not considered (i.e., it is disregarded) in calculating eligibility for, and the amount of, pension payments if it is now, or is to be, spent on such medical-related expenses. These expenses can include costs not covered by one s health insurance; insurance co-payments and deductibles; transportation to medical care (busses, subways, taxis, tolls, parking fees, gasoline & mileage); premiums for Medicare and any other health insurance; care, services or drugs not provided by or through and to be paid for out-of-pocket in cash---other health coverages or Medicaid; and even in most cases medical costs of non-veteran family members. For a single veteran in 2012, this means that other, ordinarily countable, income over $49.29 monthly, which is 5% of the prior year s (i.e., 2011 s) monthly single veteran pension rate--- if it s to be spent on medical care--- won t be deducted from his or her pension amount. This feature is called the Unreimbursed Medical Expense or UME deduction, and is a way of shielding income meant for medical care from being counted as income in the VA pension eligibility budgeting calculations. To adjust one s pension to take account of income spent on medical care, use VA Form See the example in the sidebar below. VA Medical Care Eligibility and Enrollment All veterans (except possibly those with income and/or assets well into the upper middle class or wealthy ranges) with honorable or general discharges who have served at least 180 days of active duty can receive care at VA medical centers -- even if they are not disabled under VA or Social Security rules or have not served in a war zone or during wartime. High-priority, free care, regardless of income or assets, with no co-payments is guaranteed to those with serviceconnected disabilities above 50%, former prisoners of war, those with what the VA has defined as catastrophic conditions, and any veteran (whether or not he or she has a service-connected disability) for at least two years after he has served in a combat zone. (But see the sidebar below CANN th St., NW Washington, DC (202)

5 for details about, and exceptions to, the two year service minimum for those who first enlisted after September 7, 1980.) Care available through the VA includes inpatient hospital stays, outpatient hospital services, clinic and physician services, surgery, complete laboratory and radiological services, outpatient prescription drugs, home health care, pensions with Aid and Attendance increments for invalids and even nursing home care (those with 100% service-connected disabilities have first priority for nursing home care; those with lesser service-connected disability ratings (of 60% to 70%) have second priority; and those with no service-connected disability have last priority; space and financial limits almost always limit the availability of VA-paid nursing home care to those with 100%---or at least 60% to 70%-- service-connected disabilities, although others are at least theoretically eligible as lesser priority cases; see pages 37 and 38 for details). According to a GAO study, nearly one third of VA medical centers then failed to offer home health services (as they re required to do) and some improperly deny them to eligible, but non-service-connected, veterans; in response, the VA promised in 2003 to begin making home health care more widely and equally available (see ). Besides hospitals, there are hundreds of freestanding VA outpatient clinics; lists locations in each state. Veterans typically begin the enrollment process with interviews at VA medical facilities, bringing discharge papers (DD214s) *, documentation of any private health insurance they might have and, for those of limited income seeking Priority Group 5 or 7 care (see below), proof of dependents, income and net worth (assets other than lived-in homes & one car). Enrollment is completed once veterans are assigned to a Primary Care Team (often denoted by colors: red, green, etc.) and are scheduled for Team intake examinations---after which referral to specific departments and clinics for ongoing care is arranged and scheduled. After either the enrollment interview or the intake examination, they re issued VA patient identification cards, usually with photos (those with purple triangles indicate the coveted, priority status of service connected ). But, anytime, those presenting themselves at the emergency room for genuine emergencies--- even those who haven t yet applied for or completed the regular enrollment process!--- are seen with the same medical triaging, waiting and processing used at any hospital emergency room. In practice, a not-yet-completely-enrolled veteran arriving at a VA emergency room without any documentation (proof of discharge, income and assets, health insurance papers), who verbally alleges he s a qualified veteran will be treated for emergent care and, if medically essential for * Most veterans keep copies on hand of their discharge forms (DD214s); but those who ve lost them can request copies by writing to the National Personnel Records Center (Military Personnel Records), 9700 Page Avenue, St. Louis, MO One can also request military medical care and other records from this facility. Requests can be made with an ordinary written letter, or on a SF 180 form, downloadable at or at Provide one s full name (including maiden name for women who later married), birth date, dates of service, military service number, Social Security number, branch of service, military rank at discharge and current address. Getting a response can take months---and a 1973 fire destroyed many of the only known copies of many records stored prior to that date. CANN th St., NW Washington, DC (202)

6 life or limb, he ll even be admitted to inpatient care. But if he doesn t medically require inpatient admission or anything more than outpatient emergent care in the ER, he won t be given free VAissued prescriptions on-site (although he would be given VA-issued prescriptions which he could pay for himself at private, commercial, civilian pharmacies). Those not-yet-fully-enrolled patients arriving at ERs with documentation of discharge, income and assets and insurance are handled the same. But, if they re not admitted overnight, they will be given free or low co-pay prescriptions--then and there at the VA s in-house pharmacy---that the VA physician orders. Assume a veteran moves from one area of the nation to another---and, in particular, if he or she (perhaps only nominally or temporarily) moves from one area to another to avoid long waits in his or her own home area (e.g., to take advantage of shorter waits for the initial intake exam and primary care team assignment in a less-crowded area) for Priority 5, 7 or 8 non-service-connected veterans' health care. The move to the new area does not mean that he has to re-enroll all over again and again face a long wait for his initial intake exam and assignment to a "primary care team". When an already-enrolled, already-examination-intaked Priority 5, 7 or 8 non-serviceconnected veteran moves to a new area, he need only appear at the nearest VA hospital or clinic for care or the routine scheduling of care, without the need to wait for a new intake examination. Showing his VA ID card (issued at first enrollment) and mentioning his Social Security number calls up his record on the VA's nationwide computer system. In such cases, the veteran would, of course, be assigned by clerical intake staff to a "new" primary care team at the new hospital or clinic (a necessity, of course, because of the move!). There would then be only the same waits for primary care appointments or specialty care referrals as are faced any other local, alreadyenrolled, already-intake-examined veteran. (But, of course, those "routine" waits can be, and sometimes are, weeks or even possibly months even in the busiest VA hospitals and clinics.) To cope with recent years crowding, the VA issued regulations to give first priority in scheduling intake examinations to those veterans who have service-connected, VA-recognized disabilities; others, including those whose disabilities are non-service-connected (even if only recognized by Social Security), have a secondary priority. Yet until recent years Congress has appropriated huge increases for the VA health budget and may continue to do so. Higher VA health budgets were once popular with both parties: Conservatives almost always favored such military -type expenses; while liberals know well that the VA cares for the poor, the disabled and the elderly. But by 2011, GOP Members of Congress began to question the rising VA budget. VA Health Care Priority Groups, Service-Connected Veterans and Co-Payment Rules Except for genuine emergencies, the VA prioritizes access, waiting times and medical service availability for elective and other non-emergency care, using eight priority groups: 1. 50% or more service-connected disabled veterans 2. 30% and 40% service-connected disabled veterans 3. 10% and 20% service-connected disabled veterans; former prisoners of war; Purple Heart recipients 4. Veterans, no matter how rich, whom the VA finds to be catastrophically disabled, even CANN th St., NW Washington, DC (202)

7 if from a non-service-connected cause, (see sidebar below for a list of qualifying conditions); or who get pension or compensation payments for Aid and Attendance or as Housebound; and those who served in war zones within the last two years, even if they re otherwise ineligible in another Priority Group. 5. Non-service-connected veterans considered poor under VA income/asset rules (see below) 6. Vietnam War ( ) Agent Orange victims and those with other designated conditions that can be presumptively considered service-connected; in particular, Vietnam, First Gulf War ( ) and Iraq (1998- ) and Afghanistan (2001- ) War veterans with Gulf War Syndrome and other designated conditions that can be presumptively considered serviceconnected (see Pages 16, 17 and 18 below for the latest listings). 7. Non-service-connected veterans considered near poor under VA income/asset rules (see below) 8. Non-service-connected veterans not considered poor or even near poor under VA income/asset rules (see below) Service-connected veterans always get free care, without even the $8 or $9 prescription copayments, for their service-connected conditions---no matter how high their income or assets. If they have private health insurance it is never billed for treatment of service-connected conditions. But service-connected and other Priority 1 through 3 veterans must pay the copayments of the Priority 5, 7 or 8 Groups that their incomes and assets would otherwise assign them to for treatment of non-service-connected conditions-- except that those rated 30% or more service-connected disabled are exempt from paying the (Priority Group 5, 7 or 8) nonprescription co-payments (even for non-service connected conditions care) that their incomes and assets would otherwise require of them. In other words, a service-connected veteran, no matter how high his income or assets, is exempted even from paying the applicable income/assetbased Priority 5, 7 or 8 co-payments (except for prescription co-payments) that he deserves by reason of income, for care of a non-service-connected condition, if he s rated 30% or more service-connected disabled. So even service-connected and other Priority 1 through 3 veterans---in particular, those rated 30% or below---still do need to have their income and assets evaluated in order to be assigned the applicable Priority Group 5, 7 or 8 co-payment schedules (but, if they re very poor, the prescription co-payment exemptions mentioned below might apply to them too) for treatment of non service-connected conditions. Any co-payments due (and in particular, any overdue, total co-payment debt) can be waived on grounds of equity and good conscience by hospital fiscal officers (see amendment to 38CFR17.05 in the 4/20/2004 Federal Register). Since May, 2010, all Priority Group 4 veterans have no co-payments at all (even for prescription drugs), whether for treatment of service-connected or even for non-service-connected conditions. Upgrading Bad Conduct, Dishonorable, Less-Than-Honorable & Undesirable Discharges; Having Early or Other Discharges Reclassified To Being For Disability or Hardship Bad conduct, dishonorable, less-than-honorable or undesirable military discharges, and tooearly or other discharges that need to be rewritten to more clearly reflect that they were actually for hardship or disability reasons---which may now unfairly prevent eligibility for VA health care, pensions, compensation or other benefits--- can be changed by applying to each military CANN th St., NW Washington, DC (202)

8 service s discharge review board. The website offers clear, concise explanations and instructions for doing so, with relevant forms and addresses. For attorneys and other professional advocates who need more exhaustive information, the National Veterans Legal Services Program (www.nvlsp.org) sells a good discharge upgrade manual for about $100. What About Those Veterans Who Seek Only VA Prescription Drugs But Want To Retain Their Own Civilian Doctors? Some veterans may argue that enrolling in VA medical care (for example, to gain valuable prescription drug coverage) might require their giving up their own civilian doctors (whom they see through Medicare or as patients in various low income clinic programs). Actually, this isn t so. There s no rule denying VA eligibles the right to also see civilian doctors at non-va expense---and, in fact, a surprising number do so. As mentioned in the previous paragraphs, VA facilities are very crowded now precisely because many older veterans use their Medicare to see civilian doctors but then go to the VA to (redundantly) see VA doctors to have the prescriptions they need written on VA prescription forms which they then fill at the VA for $8 or $9! The VA s rules still require that its prescription drugs are only available for prescriptions written by VA doctors for patients they actually see. So, to get VA-covered drugs, many older patients go through the motions of seeing a VA doctor to get him to write the very same prescriptions that their civilian doctors have already ordered for them---but now on VA prescription forms. VA doctors know this and are quite used to it---they quickly assess the patient s state of health and what prescriptions the civilian doctor ordered. If everything seems reasonable, proper and necessary they quickly counter-issue the desired prescriptions on VA forms, send such patients on their way and rapidly move on to their many other tasks. Of course, even abbreviated, pro forma, but redundant, VA patient visits like these are wasteful of VA resources (and the time of patients, who resent having to be seen by a second doctor just to get VA drugs). But under its current rules, the VA requires that its own doctors be responsible for decisions to issue prescriptions. Some veterans, members of the public, Congressmen and the General Accounting Office have called for considering abandoning the see a VA doctor first prescription rule and the VA has begun to study doing so. But, for now, the VA still maintains its requirement that, in general, VA-issued prescriptions can only be written by VA physicians for those veterans whom they actually see as patients. Nevertheless, the GAO, many Members of Congress and some veterans' organizations still want regular, ongoing access to VA-issued drugs for those who remain in treatment with private doctors---and the VA has said it is considering such a permanent change in policy. More On VA Prescriptions VA prescriptions are issued by the prescribing doctor on a VA prescription form, which usually indicates how many refills are to be allowed. Patients then drop them off at in-house VA pharmacies---where, typically, dozens of patients are waiting at any given time. With waits that usually exceed those at commercial pharmacies, patients are given their prescriptions (they then pay or are later billed by mail for their $8 (for Priority Groups 2, 3 and 5) or $9 (for Priority CANN th St., NW Washington, DC (202)

9 Groups 7 and 8) co-pays. Those non-service-connected veterans claiming exemption from copayments because they can t afford them (see below) at this point can encounter time-consuming red tape that might well require an hour or two more of processing (and only then if the finance and pharmacy offices are open for such business). Service-connected veterans are not charged co-payments for care related to their disabilities. And, yes, in practice the difficulties VA staff faces in distinguishing, Solomon-like, between care for service-connected and other non-serviceconnected conditions can, and often does, result in some service-connected veterans getting copayment exemptions for care for what may really be non-service-connected conditions. Patients can---and, where it s medically possible, many do---choose not to wait on-site for the prescription to be filled: They can instead opt for mail delivery to their homes (most prescriptions not picked up on the day of submission are mailed out the next afternoon). But this can, and often does, take several days or even a week; shipments are often late or lost in the mail; and medications that are narcotics or are heat- or refrigeration-sensitive can t be mailed at all. Patients pay their billed co-pays by mailing back checks or money orders. But those who become seriously delinquent may have to make on-site, up-front cash co-pays for future prescriptions. The VA, as a federal agency, is not subject to applicable state medication prescribing and dispensing laws. Hence, patients generally must accept what the VA physician orders; for example, they can t (without convincing the prescribing doctor or, what s worse, going through the long, arduous appeals process) ask for a brand name instead of a medically equivalent generic or invoke other substitution options that might be available under state law at commercial pharmacies. It s also important to note that the VA permits even registered nurses and physician assistants to prescribe in many cases---even where otherwise-applicable state law might not permit this for prescriptions to be filled at ordinary civilian, commercial pharmacies. For details on VA drug prescribing policies and practices---including how the VA formulary (i.e., list of covered drugs) actually can and does fully meet variable medical needs and does not adversely constrict patient access to genuinely necessary off-formulary drugs see The Big One in Volume 7, Issue 8 (2/22/07) of the Asclepios e-newsletter at And the VA can, and often does, allow prescriptions to be refilled more times than is allowed at civilian pharmacies. Patents can request this when first given prescriptions and as they drop them off at the VA s own on-site pharmacies. Refills can be scheduled/diaried for automatic mail refill or can be re-ordered via telephoned-in computerized systems. Those who don t wish to wait at the VA for their prescriptions---if they re willing and able to pay cash themselves--- can even fill those signed by a state-licensed physician at private, commercial pharmacies. One nice advantage of the VA system is that it issues prescriptions (at the often-attractive bargain price of only an $8 or $9 co-pay) for many over-the-counter items---bandages, dressings, braces, lotions, salves, cough medicines, antacids, patent medicines, crutches, canes, walkers, wheelchairs, adult diapers and other first aid supplies---that civilians must pay full cash prices for even though they may not need MD prescriptions to buy them at civilian drug stores. Transportation To Distant VA Hospitals and VA Medical Travel Payments CANN th St., NW Washington, DC (202)

10 In metropolitan areas with good, economical public transit, getting to VA medical care via buses or subways is reasonably cheap and service is reasonably frequent and accessible. But many patients living in rural or far-out suburban areas lack a family automobile, have little or no income to pay for their gas or reimburse others for rides or live in areas that aren t served by any reliable or frequent-enough public transit or even long distance bus service (e. g., Greyhound). For travel to medical care and compensation and pension ratings exams in 2012, the VA pays or reimburses---subject to a deductible of $3.00 per one way trip/ $6.00 per round trip, which is waived for the rest of a month after deductibles applied during that month total to $ at a rate of 41.5 cents per mile. Rates can be somewhat more for those scheduled for repeat ratings exams--- and deductibles can even be totally waived but only if veterans are 30%-or-more service-connected disabled; getting care for any service-connected condition; VA pensioners or those with incomes under the applicable family-sized pension level; and traveling to VA compensation or pension ratings exams. With advance authorization (unless it s for genuine emergency care), the often-even-higher costs of veterans traveling to VA medical care or ratings exams are also covered if they medically require ambulance, ambulette or special handicapped van service and can t pay the cost. And trips to ratings exams and by medically necessary ambulance, ambulette and handicapped vans aren t subject to the $3.00 and $6.00 deductibles; and also, on request, those with incomes under the applicable pension income level can be exempted from the travel deductibles. Submission of appropriate records and receipts is necessary; see VA hospital and clinic travel and/or finance offices for details and arrangements. The Disabled American Veterans (www.dav.org), a nationwide non-profit organization, provides daily, free door-to-door van transport service to disabled and indigent veterans living in areas without adequate public transportation who otherwise can t get to VA medical appointments. In many areas, only one morning inbound and one late afternoon outbound trip is offered---meaning that, even for brief appointments, whole days are consumed. On the DAV website, the terms transportation network, hospital coordinator and volunteer services refer one to a hospital-by-hospital listing of, and telephone numbers for, those DAV workers who supervise the van transport system serving each hospital. They have details about local van service, scheduling, reservations and priorities. The drivers are usually volunteers as are many of the transport coordinators. Donations fund this private, non-profit system. Those veterans living in very remote areas (e.g., the Alaska bush, Hawaii s Neighbor Islands, parts of the Mountain States and many US overseas territories) and need to travel to distant VA or other medical facilities---if they re ambulatory and don t need medical care on route may also be eligible for free air transport from Angel Flight America (www.angelflightamerica.org ; ), a private non-profit group. Proof of financial need may be required. Case Management and Patient Advocacy for VA Patients Because the VA is a classically large, often-impersonal bureaucracy, patients needs can sometimes be overlooked or forgotten: Mail-ordered prescriptions may not come on time or at all; mail-order and other prescriptions may expire, their expiration perhaps overlooked by busy physicians; and more vulnerable, less self-proactive patients may not get the detailed case management and treatment/drug regimen training that they need. CANN th St., NW Washington, DC (202)

11 While the VA benefits system does offer appeals and hearings for those who are aggrieved, it is attuned almost exclusively to the needs of those seeking money Pension and Compensation payments rather than timely, quality medical care and related supportive services. Veterans have one year after the denial of a benefit, or being given a substandard service, to appeal in writing to their servicing VA Regional Office, using VA forms available at or even by simply writing a letter. But in 2012 appeals are backlogged by many hundreds of thousands and typically take at least a year or two to be resolved. Hence, the VA appeals system just isn t timely enough to offer minimally-prompt help with medical care quality and access complaints. More vulnerable veterans those who are frail, are intellectually-challenged, have limited education, are confused or intimidated by the massive, complex VA system, or need detailed case management, guidance and assistance with appointment schedules, treatment orders or drug therapy regimens--- can seek help from, or be referred to: the service representatives (middleaged and older veteran volunteers from groups like the American Legion, the Veterans of Foreign Wars, etc. who work from offices right in VA hospitals although what skills they have are more often focused on Pensions and Compensation questions); Patient Advocates and Ombudsmen are on staff in VA hospitals just as they are in civilian hospitals and handle complaints about treatment and quality of care; and VA hospitals own Social Work staff in each medical department offer treatment-related supportive counseling and services to all VA patients, including even those treated by outpatient clinical departments. The VA medical care system, at least theoretically, requires one to secure unscheduled or between-appointments medical care through the Emergency Room. But that can take many hours wait, only to be seen by a generalist physician unfamiliar with the patient s individual care. He can (at most) offer temporary care solutions and impermanent, stopgap prescriptions for expired, lost-in-th or about-to-expire medications. Some more proactive patients successfully deal with this inevitable eventuality by chatting up friendly acquaintance-ships with---and getting direct phone numbers for--their main treating clinical department s receptionists, clerks, nurses and social workers. These contacts can then squeeze them in for lastminute appointments or arrange to have a physician renew an expiring prescription or write a stopgap prescription for one that s lost or delayed in the mail. Special Rules For VA-Paid Care at Non-VA Facilities Note that (except for rare, arranged-in-advance purchases of specialty care at non-va hospitals) the VA does not pay for care at non-va facilities, with three exceptions: First, with advance permission, some veterans usually, only those who get service-connected compensation benefits (see below) can be treated by selected non-va medical staff or facilities in parts of the Mountain States and central Florida under special, limited pilot programs. Secondly, service-connected compensationers--but not other veterans can with advance permission be treated by approved foreign medical providers and foreign US military medical facilities for emergencies when overseas. Contact the VA Foreign Medical program office, P.O. Box 65021, Denver, CO (303) (call [877] if living or traveling in Australia, Britain, Costa Rica, Germany, Italy, Japan, Mexico, Panama or Spain). There are CANN th St., NW Washington, DC (202)

12 numerous authorization and billing forms that may be required. Request a copy of the pamphlet Department of Veterans Affairs Foreign Medical Services Program. Nevertheless, in spite of the restriction of care at overseas US military medical facilities only to service-connected compensationers who have secured advance permission, there are anecdotal reports that other veterans who have VA patient identity cards have secured emergency care at overseas U.S. military medical facilities. This is because non-va-employed military hospital clerks there understandably have trouble mastering the VA s complex (and, to them, alien) rules. Hence, they might well fail to distinguish between eligible and ineligible VA patient identity cardholders. Lastly, any otherwise-eligible veterans----but only if (1) they have already enrolled for VA health benefits; (2) have already received some actual VA treatment within the last 24 months; and (3) are not covered by private health insurance, Medicare or Medicaid----can receive emergency care paid for by the VA at a non-va hospital in the US when 1) such a hospital is nearer than a VA one and 2) delaying care to reach a more distant VA facility (under a prudent person standard) would seriously endanger life or health. Ambulance and related emergency medical services which appear necessary (also under a prudent layperson standard) can likewise be covered. In cases of inpatient admission or emergency room care, the veteran, his family, his legal representative or the non-va facility s staff itself must get authorization from the veteran s regular VA clinical staff within 48 hours. That VA staff also decides when the patient is medically ready for discharge or transfer to a VA facility---after which VA liability to pay for authorized and covered care at a non-va facility ends. Coverage of Eyeglasses, Hearing Aids & Related Exams and Dental Services The VA not only covers eye examinations and audiology tests and writes eyeglass and hearing aid prescriptions for its eligible patients. In many cases it also actually provides eyeglasses and hearing aids---sometimes even for some non-service-connected Priority 4, 5, 6, 7 and 8 patients. Veterans' Health Administration Directive of July 5, 2002 [paragraph 4.a.(1)] authorized eyeglasses and hearing aids for: * those getting service-connected compensation for any reason or at any percentage; * former prisoners of war and those awarded Purple Hearts; * those getting Housebound or Aid & Attendance increments to needs-based disability pensions; * those needing eyeglasses or hearing aids due to any other (even non-service-connected) significant medical cause, such as those that limit Activities of Daily Living (ADLs) ; and * those with any other functional or cognitive impairment-- as shown by ADL deficiency(ies) needing eyeglasses or hearing aids to participate in their own care. Replacements are allowed in cases of loss and breakage and for new or changed prescriptions. Hearing aids, without a prescription change or loss, must last 4 years. Issuance of spares and replacements is determined by the audiologist or eye care specialist. Yet in spite of this directive, the VA website (accessed 12/14/09 and since then) quite contradictorily states that eyeglasses and hearing aids are provided only to serviceconnected veterans, to former prisoners of war and to some other very limited categories. CANN th St., NW Washington, DC (202)

13 Middle class persons only recently plunged into poverty by disability or illness often continue to think that eyeglasses for reading and driving can only be prescribed and purchased through professional ophthalmologists, optometrists and opticians (eyeglass stores). Yet, as the longterm poor already know well, such outlets as Sears, Target, Wal-Mart, CVS, Walgreen s, Dollar Stores, Rexall, Rite-Aid and Eckerd s actually sell off-the-rack, ready-to-wear eyeglasses, in a wide variety of differing strengths (e.g., to ), for reading and driving at far better prices ($15 or so--or even much less-- a pair vs. what could be as much as $120 and up at optician stores). In fact, the American Academy of Ophthalmology finds that Ready-to-wear reading glasses are effective, safe and economical. Self-selection and over-the-counter purchase of these glasses appears to be medically acceptable, cost-effective and in the best overall interest of the public. But while these glasses work well for those with simple prescriptions---or who only seek spares for contact lenses they usually wear---they are not adequate for those with astigmatism; those who need different strength prescriptions in each eye; or those whose eyes are very close together or far apart. Since ready-to-wear glasses are usually labeled with their strengths, wise shoppers who can afford to do so can and should seek strengths that match prescriptions written for them by physician-ophthalmologists. Optometrists can also prescribe them---but then they ll likely also try to sell one their own more costly professional eyeglasses. Dental services ordinarily are offered by the VA only to 100% disabled, service-connected veterans, those whose service-connected conditions include dental problems and those held as prisoners of war for at least 90 days; but other, non-service-connected ones may apply, but only within 90 days of discharge from active duty, to get dental care that wasn t completed during active duty. Often, the VA then authorizes and pays for care with private dentists it contracts with. However, Section 513 of the 2010 Caregivers and Veterans Omnibus Health Services Act authorizes a 3 year pilot program to assess the feasibility of offering all veterans---even nonservice-connected ones--va-sponsored dental insurance (to be paid for by veterans premiums). Those not eligible for VA eye care might contact the Seniors Eyecare Program ( ; ) if they re limited income citizens or legal aliens over 65; it offers some limited eye care---although not eyeglasses or eyeglass prescriptions. Local Lions Clubs United Way affiliates Salvation Army chapters and, above all, the Lenscrafters Gift of Sight Program ( ) sometimes offer help with eye exams, eyeglass prescriptions and/or eyeglasses. New Eyes for the Needy offers vouchers to purchase eyeglasses to those it finds eligible. The American Academy of Otolaryngology (www.entnet.org/healthinfo/hearing) lists some resources for free or discounted hearing exams and hearing aid resources---as do some Easter Seal Society (www.easterseals.com) groups. For dues-paying members, the Costco stores offer free hearing evaluations by audiologists and licensed hearing aid professionals at 200 locations; call But most important of all, the Starkey Hearing Foundation (www.starkey.com; ) provides over 10,000 hearing aids a year to the needy using its own privately-set income eligibility rules. Most state Medicaid programs deny dental care (other than emergency extractions to relieve pain), dentures, eyeglasses and hearing aids to adults. Go to for CANN th St., NW Washington, DC (202)

14 data on states Medicaid coverage of these services. In addition, the report State of Decay at surveys whether, and to what extent, each state Medicaid program covers adult dental services. However, the National Association of Dentistry for the Handicapped (www.nadh.org; ) organizes dentist volunteers to give free dental care to poor disabled persons in at least 32 states. With long waiting lists, almost all dental schools offer heavily discounted, very low-fee dental care by student dentists whose work is closely supervised by dental professors. The American Dental Association (www.ada.org; ) has a list of all American dental schools and itself also enlists dentist volunteers to give free care to the needy aged in its Access to Oral Health Care for Older Americans program. Where state Medicaid programs don t cover dental care---especially routine care for adults over age 18, which most don t offer---about 70% of federally-supported low income health clinics do so for free or for heavily discounted fees (but they have very long waiting lists). There s a list of such local clinics at Other, non-federally-funded low income clinics might (but it s less likely) also offer dental care; see their state-by-state lists at Also, local health departments will know of any other local low income dental clinics. Check the website of the Association of State & Territorial Dental Directors (www.astdd.org ) for data on dental assistance programs in each state and a list of state dental directors, who have even more details about resources in their states. Call individual clinics first about dental care availability. Medical Care Rules For Priority Group 5: Income, Assets and Co-Payments In 2012, single non-service-connected veterans with annual incomes below $30,460 yearly, or $2, monthly ----known as Priority Group are eligible for free care without any copayments (except for $8 per prescription), after those with service-connected and catastrophic disabilities, former prisoners of war, those who served in combat zones within the past two years and certain other priority classes are served. ($6, more yearly---$ more monthly--- is allowed for one dependent and $2,093 more yearly---$ more monthly---is allowed for each additional one; here, too, in 2012 the first $9,750 of a child s earnings is not counted.) Allowable assets per family include a lived-in home of any value, one vehicle of any value and $80,000 of Net Worth in other vehicles, boats, bank accounts, savings, investments, other real estate, etc. (but in 2010 the VA began more flexibly applying the $80,000 Net Worth asset level for medical care; see page 28). If a veteran does happen to have private health insurance, the VA will bill the plan for what it can, but it will not bill the veteran if he or she has income below this level, except for the $8 prescription co-payment (the only co-payment for Priority 5 veterans). Suspending All Rx Co-pays for the Very Neediest Veterans and Those With Many Rx s PriorityGroup 2,3, 5and 6 veterans prescription co-paymentscan besuspendedfor therest ofthe year once they incur $960 of such charges in as is also true for any applicable prescription co-payments that might otherwise be required of 40%-or-less service-connected disabled veterans or for treatment of a service-connected disabled veteran s non-service-connected conditions. In addition, all veterans with incomes under the prior year s applicable basic pension level(so, for example, in 2012, that would be 2011 s $ monthly pension level for a single veteran, plus $ more for those with one dependent and $ more for each additional dependent) are exempt from any prescription co-payments. When first enrolling for VA care, those under this income level should be sure to insist that their enrollment file specifies that they re designated CANN th St., NW Washington, DC (202)

15 as co-payment-exempt for prescriptions; and those who originallyenrolled at higher income levels---but whose income later falls to within the co-payment exemption income range---should re-visit the VA hospital or clinic s enrollment/eligibility office with revised, current proofs of reduced income to request that their records be corrected to now exempt them from drug co-payments. Debts owed to the VA for co-pays can be waived on grounds of equity and good conscience by hospital fiscal officers (see amendment to 38CFR17.05 in the 4/20/04 Federal Register). VA Care With Added, Small Co-Pays For Wealthier Priority Group 7 Veterans After higher-priority cases such as service-connected disabled veterans, former prisoners of war and lower income Priority Group 5 veterans are served, VA medical centers may at their option also give care to Priority Group 7 veterans----those non-service-connected veterans whose incomes exceed the Priority 5 eligibility levels but are below Priority 8 levels. Priority 7 Net Worth asset ceiling levels are the same as for Priority 5, however---namely, $80,000, not counting household goods, a lived-in home of any value and one vehicle of any value (but in early 2010 the VA began much more flexibly applying its originally-hard-and-fast $80,000 Net Worth asset eligibility level for medical care; see page 28). The special 2-years-of-service minimum for those who first enlisted after 9/7/80 applies here too; see the accompanying sidebar. In Priority 7 cases, some other co-payments are charged---$0 for preventive care outpatient appointments, $15 per primary care outpatient encounter, $50 per specialty care outpatient encounter and $2 per night plus $ for some or all of the first 90 days of inpatient hospital care in 2012 (and $ plus $2 per night for many subsequent inpatient hospital stays within 2012) and, since 2010, $9 per monthly prescription supply---but this is still far, far cheaper than it would be for those who d otherwise need to pay full costs in cash or do without. And if these near-poor veterans do happen to have some private health insurance, any payments collected from the insurance to the VA for the care are counted off the amount the veteran must pay in co-payments. See the chart below of VA medical care co-payments for Priority Group 7 veterans. VA Care with Even Bigger Co-pays for Even Wealthier Priority Group 8 Veterans On October 1, 2002, the VA created a new Priority Group 8 for health care eligibility to implement the VA Health Care Programs Enhancement Act, which was enacted in January, Priority 8 patients are those non-service-connected veterans with a net worth in assets over $80,000 (not counting household goods, a lived-in home of any value and one vehicle of any value; but here, too, the VA in early 2010 began more flexibly applying the originally hardand-fast $80,000 Net Worth asset eligibility level for medical care; see page 28) and/or income over the levels used by HUD as the upper limits for lower income housing assistance eligibility. The HUD levels---which the VA calls Geographic Mean Test (GMT) levels-- vary state-bystate, by Standard Metropolitan Statistical Areas (SMSAs) within states and by family size, depending upon local costs-of-living. See the sidebar below and the VA website to locate a local area s income level for dividing Priority 7 from Priority 8 veterans. Non-service-connected veterans ABOVE this income level are now in Priority Group 8! Priority 8 patients must make co-payments of $9 per prescription, $15 to $50 per outpatient physician encounter, $1,156 plus $10 per night for some or all of the first 90 days of inpatient CANN th St., NW Washington, DC (202)

16 hospital care in 2012 and $578 plus $10 per night for many subsequent hospitalizations during Here, too, any private health insurance which a veteran has is billed, and then, any payments the VA receives from the insurance, are counted off what he owes it for co-payments. But on January 17, 2003, the VA published Interim Final Regulations in the Federal Register (Vol. 68, No. 12, pp ) immediately suspending further enrollment of Priority 8 veterans. Yet newly-applying richer veterans who d now be classified as Priority 8 who are determined by the VA to have catastrophic disabilities (even non-service-connected ones; see the sidebar below) can still become eligible in Priority Group 4. And even those without such catastrophic disabilities who had already enrolled and originally qualified for Priority Groups 5, 6 or 7 but whose income or assets only later rise into the Priority Group 8 range are "grandfathered-in" and not totally disenrolled; they re merely transferred to Priority Group 8. But then, President Obama, in his 2008 election campaign, pledged to revoke the 2003 Bush Administration regulation banning enrollment of most Priority Group 8 non-service-connected veterans--and Congress, in the Fiscal Year 2009 VA appropriation bill, authorized funding for re-opening Priority Group 8 enrollment; so the VA issued regulations (pages in the May 15, 2009 Federal Register amending 38 Code Of Federal Regulations 17.36) opening Priority Group 8 enrollment to those whose incomes are up to 10% above the applicable 2011 Priority Group 7-Priority Group 8 income level divide (formally known as the 2010 GMT [Geographic Means Test] Threshold levels appearing in the Health Enrollment and Eligibility pages at ). Moreover, the statutory and regulatory wording that liberalizes Priority Group 8 enrollment has the additional, further-liberalizing and surprisingly pleasing effect (whether intentional or not) of totally dropping the Net Worth (asset) test for those veterans in the liberalized Priority Group 8 category (also see page 28). Also, Section 515 of the Caregivers and Veterans Omnibus Health Services Act, which became law in May, 2010, bars the VA from imposing any co-pays at all (even for prescription drugs) on any Priority 4 non-service-connected veterans, even if they d otherwise financially merit the copays of the Priority Group they d ordinarily be assigned to based on their income or assets alone. Compensation For Veterans with Service-Connected Full or Partial Disabilities The VA pays compensation to veterans whose disabilities arose from their time in active service -- even if off-base, off-duty, on a pass or on leave and whether or not overseas or during wartime. These service-connected disabilities can include disease or injury that a veteran proves was contracted during service, even if disabling symptoms only appear after discharge. (Conditions for which treatment is sought and documented within one year of discharge can be presumed to be service-connected too, even in the absence of contemporaneous medical records from the actual calendar periods of active duty.) Military medical records and even evidence from non-military sources---can be used to demonstrate this. Here too, appearing for VA ratings examinations is almost always required as well. It s usually a long, legalistic process---which is what generates the well-known, huge VA appeals backlog. But veterans who can demonstrate any percent of service-connected disability are entitled to lifetime tax-free monthly payments. In 2012, single veterans can get monthly service-connected compensation awards for disabilities that cause partial incapacity in increments of 10% ($127), 20% ($251), 30% CANN th St., NW Washington, DC (202)

17 ($389), 40% ($560), 50% ($797), 60% ($1,009), 70% ($1,272), 80% ($1,478) or 90% ($1,861)---and, of course, at a full 100% ($2,769). Rules in force since early 2003 provide that in-country Vietnam veterans who now have diabetes are presumed automatically to be service-connected disabled if rated at least 10% (20% if also on regular medication for diabetes), with higher ratings possible for serious diabetic complications (amputations, serious and recurrent wounds, cut or abrasion healing deficiencies, peripheral neuropathy, poor circulation, cardiovascular and kidney problems, etc.; for details, enter Agent Orange in the search box at and then read the diabetes discussion in the material that comes up). Current tracheal, laryngeal, bronchial and lung cancers; Parkinson s Disease; ischemic heart disease; B-cell leukemias; Chronic Lymphocytic Leukemia; acute and sub-acute peripheral neuropathy; AL Amyloidosis; Chloracne (or similar acneform disease); Hodgkin s Disease; Multiple Myeloma; Non-Hodgkin s Lymphoma; Porphyria Cutanea Tarda; prostate cancer; and soft tissue sarcomas (other than osteosarcoma, Chondrosarcoma, Kaposi s Sarcoma or Mesothelioma) of in-country Vietnam War veterans can be presumed to be service-connected due to exposure to Agent Orange. The same presumption, for service-connected disability purposes, also applies even to veterans who served in Korea from April, 1968 to July, Veterans of the First Gulf War--and now any conflict or war-zone-related assignment--- who presently have ALS (Lou Gehrig s Disease) are automatically presumed to have a 100%, full service-connected disability (for details, enter ALS or Lou Gehrig s Disease in the search box at ). In 2004, the VA also began automatically presuming multiple sclerosis in Vietnam and post- Vietnam war zone veterans as being service-connected (for details, enter multiple sclerosis in the search box at ). The more elusive, hard-to-diagnose-and-document Gulf War Syndrome conditions of those who served in the First Gulf War, the Iraq or the Afghanistan Wars combat zones in many cases can also merit compensation awards---as can some cirrhosis cases. On September 28, 2010, the VA issued a regulation adding the following conditions as presumptively disabling for veterans who ve served in Southwest Asia and Afghanistan: brucellosis, campylobacter jejuni, Coxiella Burneti (Q fever), malaria, Mycobacterium tuberculosis, Nontyphoid salmonella, Shigella, Visceral leishmaniasis and West Nile virus. Nevertheless, presumptive eligibility for these conditions does not mean automatic eligibility: some medical proof or documentation---and, as always, a VA ratings examination is generally required too. Those veterans rated at 30% or more service-connected disabled can have dependent allowances---which rise with the percentage of disability-- added to their compensation payments, and, if they medically qualify for it, the compensation program s own Aid and Attendance and Housebound enhancements (benefits with similar qualification rules, but distinct from, that for pensioners), which of course requires submission of medical documentation and a CANN th St., NW Washington, DC (202)

18 VA ratings examination. In addition to basic dependent increments for spouses and up to $46 or more each child who is in school or helpless and under age 18 for veterans rated 30% or more, the compensation program for them also pays a monthly increment of up to $173 or more for each child over 18 if attending attending college or trade school--- again, with rates rising with the percentage of disability. Spouses of 100% service-connected disabled veterans who qualify for Aid and Attendance themselves can get up to $99. See the Rate Tables under Compensation and Benefits at for details. In addition to the above payments, in 2012 veterans rated fully or 100% service-connected disabled (and perhaps, in some cases, even those rated only 60% to 70%) may qualify for monthly Aid and Attendance payments for themselves of up to $2,002, up to $2,893 (if they need and get such services daily from by someone licensed to provide such services, or others working under a licensed health care professional s supervision) and up to $2,993 (if permanently housebound). See 38 USC 1114 (r); 38 CFR and VA Claims Manual M21-1MR for more exhaustive legal details for A &A for such eligible compensationers. Compensation is not a needs-based program like pensions, so compensationers can have any amount in other income, earnings or assets. Compensation benefits, like pensions, are rounded down to the next whole dollar in making actual payments. Post-Traumatic Stress Disorder (PTSD), Substance Abuse, HIV/AIDS & Illegal Activity VA compensation claims for post-traumatic stress disorder (PTSD, which are continuing and seemingly permanent psychological and behavioral incapacities resulting from events---often, but not always, in combat---while in military service) are well-known as part of the Vietnam veterans story, but PTSD also afflicts other veterans too. Resources and suggestions for assembling and documenting PTSD claims appear at and at other websites by entering PTSD and DSM-IV into search engines. By law, the VA does not recognize alcoholism or drug addiction as compensable disabilities themselves (it doesn t for pensions either). But underlying psychological disabilities that might give rise to alcoholism or drug addiction as symptoms are compensable: in those cases, Alcoholism or drug addiction histories can even serve as symptom evidence to buttress such claims. Injuries or illnesses resulting from illegal activities can never, under the law, be compensable. Yet, in practice, only those illegal activities which are facially quite obvious---or are (foolishly) voluntarily admitted to by a service person still on active duty (and so officially recorded), or by an already-discharged veteran in the unlikely event that VA staff directly question him on this point during claim processing---are actually considered (or, much less, are formally adjudicated as) illegal. For at least 20 years the military services have pre-screened new recruits for the HIV virus and they ve also conducted periodic re-testings of those on duty as well. As a result, few recent veterans ever submit qualifying evidence (e.g., positive tests for the HIV virus contemporaneous with military service time) that demonstrates a seroconversion before discharge. But more veterans who are HIV-positive and who served before the adoption of comprehensive military HIV blood tests (before 1990 or so) can get compensation now if they submit qualifying, contemporaneous medical evidence of being positive, having recognized HIV symptoms or seroconverting while on active duty. The VA once estimated that approximately CANN th St., NW Washington, DC (202)

19 2,800 veterans have contracted HIV through blood transfusions while on active duty, according to the St. Paul Pioneer Press (3/10/04). And this can be so in spite of the apparent roadblock that the ban on illegal activity (e.g., homosexual activity; sharing needles while using illegal drugs, etc.) seems to impose because, as mentioned above, only facially obvious, officially adjudicated or voluntarily admitted-to events, in practice, come under the illegal activities ban. (For example, an active duty serviceman paralyzed by a gunshot during a shootout with police as he robbed a bank would probably be denied compensation; but a serviceman who became HIVpositive while on active duty would not be denied compensation, absent any obvious, adjudicateed, compelling, dramatic or voluntary evidence or admission to particular illegal activities. Even if directly asked, there are other believable explanations I was in some bar fights with a lot of biting and blood ; I think I once got a transfusion after I was in a car accident, but it was so long ago that I forget where and when ; I used to see lots of (female) prostitutes ; I should have known that sitting on those dirty public rest room toilet seats could give me something, etc. Moreover, long-after-discharge admissions to post-discharge homosexual or intravenous drug activities does not compromise one s discharge or one s basic eligibility for VA benefits.) Service-Connected Disabled Veterans Dependents & Survivors & Their Medical Coverage The compensation payments go up for those with dependents and include not only priority VA medical care for the veteran himself, but also---only for 100% service-connected disabled veterans or those who die on active service---medical coverage for dependents and survivors in the VA s CHAMPVA medical insurance plan. The CHAMPVA medical insurance plan is premium-free for those who are eligible, is not medically-underwritten (there are no preexisting condition restrictions and no medical history questionnaires, blood tests or exams are needed to qualify) and it offers coverage similar to major medical plans of large employers or civilian federal employees, including some deductibles and co-payments. It can even continue to cover now-grown, but first-disabled-as-minors ( helpless adult ) children, including even after the death of the veteran and even after that of his or her surviving spouse! Where families with such grown disabled children only tardily discover the existence of this lifetime coverage, they can enroll late but only for prospective coverage (i.e., past medical expenses can t be covered). But, again, note that CHAMPVA is only for dependents and survivors of 100% service-connected disabled compensationers: Even though living veterans with as low as 30% service-connected disability ratings can get dependent income allowances added to their compensation checks, they cannot thereby qualify dependents for CHAMPVA. It s also important to note that disabled wartime pensioners (as opposed to compensationers ) dependents & survivors are not eligible for CHAMPVA or any other VA care either---although they can often get some medical expenses indirectly met by the Pension system s Unreimbursed Medical Expenses (UME) deduction provisions if they can t get Medicaid or other coverage. Dependency and Indemnity Compensation (DIC) Payments For Surviving Spouses and Children of Deceased 100% Service-Connected Disabled Veterans Surviving spouses of deceased service-connected 100% disabled veterans---or those who die on active duty-- get payments called Dependency and Indemnity Compensation (DIC), as well as premium-free, lifetime continued CHAMPVA health coverage, even if they themselves aren t CANN th St., NW Washington, DC (202)

20 disabled at all. (See the CHAMPVA pages at For a single surviving spouse widowed after 1993, the monthly payment is $1,195 in 2012; $296 more is paid for each dependent child. An additional increment of $254 more is paid in 2012 to the surviving spouse if a married veteran lived with her or him at least 8 years before his or her death while, or as a result of being, 100% disabled; or at least 5 years before his or her death after he or she became so disabled; or at least one year before his or her death if he or she was a prisoner of war. Surviving DIC spouses, if medically qualified themselves (by submission of medical records and through a VA ratings examination), also get added DIC allowances of $296 for their own Aid and Attendance-- or $139 if Housebound-- for themselves in In addition to the above amounts, the Veterans Benefits Improvement Act of 2004, HR 3936, pays still another, extra $251 DIC increment for the first two years after the DIC initial award date where a surviving spouse has one or more minor dependent children (and $505 each month for helpless child[ren]). The DIC program, like that for Pensions, makes a helpless adult child payment (and gives lifetime CHAMPVA coverage) to grown, 100% disabled children first incapacitated as minors (which, of course, also requires submission of medical records and VA ratings exams), even after the deaths of the veteran and that child s surviving parent. See the Compensation and DIC Rate Tables at DIC benefits, like pensions and compensation, are rounded down to the next whole dollar in making actual payments. Compensation & DIC Are Tax-Free, Non-Garnishable, Non-Welfare Benefits Compensation and DIC benefits are tax-free, and are not needs-based like pensions. One can have additional income without affecting a compensation or DIC payment. But, since they are tax-free and are not themselves welfare-type payments, need-based programs such as SSI, Medicaid, housing and other welfare programs can and do count them as income. VA compensation and DIC benefits can t be garnished for any private debt---except for child support and alimony orders and also except for private debt garnishments ordered in those rare, unusual cases where part of a compensation award is received in lieu of career military retired pay and that portion alone is garnished (and even this is so only because a designated portion of military active and retired pay is garnishable for private debt). For details, see 8/5/98 testimony of VA General Counsel before House Veterans Affairs Committee, which is searchable at Servicemembers Group Life Insurance (SGLI), Veterans Group Life Insurance (VGLI), Service-Disabled Veterans Life Insurance (SDVLI) and Death Benefits for Survivors Veterans being discharged have the right to retain life insurance policies of up to $400,000 in 2012, with some of that coverage premium-free for those in combat zones (with the free combat zone portion of the premium for up to the $400,000 coverage level retroactive to 2001). These policies are issued in those amounts by the Servicemembers Group Life Insurance (SGLI) plan to almost all active duty service persons, including activated Reservists and Guardsmen, and they can be converted later without medical underwriting (such as pre-existing condition restrictions, blood tests or health questionnaires) within 120 days of discharge into term Veterans Group Life Insurance (VGLI) policies or private, individual, commercial whole life policies (which have much higher premiums) for up to the same amounts through the Office of Servicemen s Group Life Insurance, at 213 Washington Street, Newark, NJ Those who are totally disabled at the time of discharge have up to one year thereafter to convert. SGLI and VGLI have small, CANN th St., NW Washington, DC (202)

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